1. Introduction to Lifestyle data Nicola Bowtell Nicola.bowtell@phe.gov.uk

2. Talk outline 2Lifestyle What do we mean by ‘lifestyle’? Why is local lifestyle data useful? Sources of lifestyle data and their comparative strengths and weaknesses

3. Lifestyle and public health Lifestyle is one of the wider determinants of health Factors include physical activity, smoking, alcohol and drug use, as well as attitudes towards behaviour 3Lifestyle

4. Lifestyle: A data snapshot Lifestyles and behaviours influence our outcomes and inequalities 21% of the adult population still smoke 61% of adults are overweight or obese Fewer than 40% of adults meet physical activity guidelines 2.4 million adults regularly drink more than recommended 4Lifestyle

5. Smoking prevalence 5Lifestyle

6. % of active adults 6Lifestyle

7. Question What’s the best way to estimate the percentage of people in your local population who smoke? 7Lifestyle

8. Potential data sources national surveys synthetic estimates based on national surveys local surveys data from primary care data from commercial/market research organisations 8Lifestyle

9. What do we really want to know? Which lifestyle factor? Smoking Physical Activity Diet Obesity Alcohol consumption What ? Between area comparisons Trends over time Evaluating local services/initiatives 9Lifestyle

10. The need for local lifestyle data : General prioritising, planning, targeting and evaluating local services and lifestyle change initiatives data at LA level and below for comparison with other LA within-area comparisons by age, gender, ethnicity, ward, practice, etc analysis of trends over time and progress towards local targets measuring the outcomes/impacts of services 10Lifestyle

11. Sources of data and strengths/weaknesses Validity – Reliability Accuracy Bias Precision Timeliness Cost 11Lifestyle

12. Data from primary care Records of consultations held on practice computers The QOF system 12Lifestyle

13. The Quality and Outcomes Framework (QOF) Obesity: The practice can produce a register of patients aged 16 years and over with a BMI greater than or equal to 30 in the last 15 months. Smoking 1: The percentage of patients with any or any combination of the following conditions: coronary heart disease, stroke or TIA, hypertension, diabetes, COPD or asthma whose notes record smoking status in the previous 15 months (except those who have never smoked where smoking status need only be recorded once since diagnosis). Smoking 2: Ditto... but where the notes contain a record that smoking cessation advice or referral to a specialist service, where available, has been offered within the previous 15 months. 13Lifestyle

14. Quality of data from primary care Advantages Standardised national systems. Ongoing data collection Established coding systems. Disadvantages Selective focus on particular patient groups Variability between practices in the completeness and quality of data recording. Lack of a geographical focus 14Lifestyle

15. Using data from commercial companies Large volumes of household survey and consumer data modelled to provide estimates for all areas of the country. Examples expenditure on tobacco, food and drink prevalence of smoking and obesity 15Lifestyle

16. QOF 16Lifestyle http://www.hscic.gov.uk/catalogue/PUB12262

17. Data from commercial organisations Advantages Extensive geographical coverage Disadvantages: the main problem is that detailed methodologies are often not available Potential for bias (lack of random sampling / poor response rates) Cost – expensive? 17Lifestyle

18. What is a survey? A survey is a way of gathering information from a sample population of interest They are a planned method of data collection Data is collected in the same way from everyone The sample should represent the population of interest Surveys can be one-off, repeated in the same population, or repeated in a different population 18Lifestyle

19. Why are surveys useful Can measure populations that don’t come into contact with services Can measure issues that are not routinely recorded, e.g. healthy eating, physical activity levels Can help us to understand the link between disease and determinant, e.g. income and mental health 19Lifestyle

20. National Surveys Health Survey for England General Lifestyle Survey 20Lifestyle

21. General Lifestyle Survey 21Lifestyle

22. General Lifestyle Survey: Prevalence of adults smoking 22Lifestyle

23. Health Survey for England Annual Survey Since 1991 Covers Physical health Lifestyle behaviours Social care Physical measures Mental and wellbeing 23Lifestyle

24. Health Survey for England All editions of the survey have covered the adult population aged 16 and over living in private households in England. Since 1995, the surveys have also included children aged 2-15 and since 2001, infants aged under 2. In 2012 interviews were held in 5,219 households with 8,291 adults aged 16 and over, and 2,043 children aged 0-15. 5,470 adults and 1,203 children had a nurse visit. In some years, the core sample has been augmented by an additional boosted sample from specific population subgroups, such as minority ethnic groups, older people or children; there was no boost in 2012. 24Lifestyle

25. Health Survey for England - 2012 25Lifestyle http://healthsurvey.hscic.gov.uk/support- guidance/public-health/health-survey-for-england.aspx

26. Other National Surveys Adult Dental Health Survey Adult Psychiatric Morbidity Survey Children’s Dental Health Survey Infant Feeding Survey Local Health and Wellbeing Survey for Younger People National Study of Health and Wellbeing NHS Stop Smoking Services Smoking at Time of Delivery Smoking, Drinking and Drug Use among Young People in England Survey of Carers in Households, England What About Youth 26Lifestyle

27. Synthetic estimates derived from national surveys Crudest approach – assume that local prevalence is the same as national prevalence In recent years academic and other groups developed modelling techniques 27Lifestyle

28. Synthetic estimates Advantages Allows comparative analysis between areas. Ease of access/cost. The estimates are in the public domain, are immediately accessible to users and are free of charge. Disadvantages Lack of flexibility – particular local requirements cannot be specified. Lack of sensitivity to local lifestyle interventions. - represent expected prevalence so additional local factors that may impact true prevalence are not taken into account, so should not be used to measure change over time. 28Lifestyle

29. Local Surveys: Advantages generates real local data flexibility and control over e.g.: population to be surveyed - area, age, sex, ethnicity, etc sample size - trading statistical power v cost survey design - cross-sectional/longitudinal, census/sample, etc method - phone, internet, interview, postal subject matter - can be anything!! 29Lifestyle

30. Local surveys: Disadvantages lack of standardisation of questions and derived indicators lack of comparability with other areas/benchmarks securing permissions labour intensive cost 30Lifestyle

31. The data and knowledge gateway 31Lifestyle

32. Nicola.bowtell@phe.gov.uk 32 www.gov.uk/phe www.chimat.org.uk datagateway@phe.org.uk Twitter@PHE_uk Twitter@PHE_children Lifestyle